In surgical procedures, sutures are commonly used to close incisions and to reunite damaged tissue. Typically, the sutures are maneuvered and passed through the affected tissue and the free ends of the sutures are individually tied together by the surgeon. In some surgical procedures, the surgical site area is sufficiently exposed to permit the surgeon to access and tie the suture manually with a surgical knot. In other surgical procedures, such as endoscopic procedures, laparoscopic procedures, arthroscopic procedures and the like, or when robotic surgical procedures occur, the surgical site is inaccessible to the surgeon's hands. As a result, the surgeon must tie each of the suture ends into a knot at a location remote from the surgical site, and then manipulate suitably configured instruments for sliding the surgical knot to the site of the incision. Further, surgeons may tie surgical knots intracorporeally (inside of the body) using surgical tools to tie the knot down to the tissue. In general, suture knot tying is cumbersome and is one of the more time-consuming steps in the suturing process of the surgical procedure. In the foregoing circumstances, it is desirable to replace knot tying during surgical procedures in order to significantly reduce the duration of surgical operations with a device or method that is simple for the surgeon to utilize. This is especially true with regard to minimally invasive surgical procedures where the tying of surgical knots within confined spaces is extremely difficult and time consuming.
Additionally, it is noted that knots create weak points in a suture. That is to say, when a failure load is applied to a knotted suture, assuming the suture is otherwise free from imperfections, the suture will break at the knot. Therefore, elimination of surgical knots in the suture would also eliminate the weak stress points created in the suture by the surgical knot.
Suture locking and suture anchoring devices such as suture clips, surgical fasteners, hinged clips, suture terminating devices, hemostatic clips, and suture fixation devices of various configurations, designs, structures, and materials of construction are well known in the prior art. For example, U.S. Pat. No. 2,075,508 discloses a suture retainer whereby a suture may be fixed relative to a surgical button. The suture is received and wedged between the button and a clamping plate in order to securely clamp the suture. There are a number of shortcomings to this retainer. First, due to the suture manipulation required to use this retainer, a laparoscopic applicator device would be extremely difficult to produce profitably. Furthermore, the wedging and clamping action will induce stress concentrations in the suture, which likely lead to reduced failure loads.
U.S. Pat. No. 6,432,123 to Schwartz et al. discloses a device comprised of a locking ring formed to have an aperture that allows a suture to pass when the suture is pulled in a first direction, but formed to lock the suture in place when the suture is pulled in an opposite direction. A locking ring is employed to compress the device upon the suture, thereby causing an increased stress concentration in the suture and thereby diminishing the failure load of the suture. Furthermore, as depicted, this device requires the user to thread the suture through a small aperture following wound approximation.
U.S. Pat. No. 6,066,160 to Colvin, et al. discloses a suture terminator device for use in minimally invasive surgery. The suture terminator device includes a pair of locking aperture with teeth for engaging a portion of a suture at the locking aperture's threaded end. Not only does this device require laparoscopically guiding two strands of suture between two very small apertures, it also requires that the sutures be squeezed tightly by these teethed apertures, thereby diminishing the integrity of the suture and significantly reducing the maximum tension the suture can withstand.
U.S. Pat. No. 6,106,545 to Egan discloses a suture tensioning and fixation device, which includes a retaining element for frictionally engaging a suture that may subsequently be melted to bond to the suture for a permanent fixation. This melting and bonding action will compromise the integrity of the suture and therefore, because suture strength is of utmost concern in most surgeries, this method of fixation of the retaining element to the suture is not suitable for most surgeries.
U.S. Pat. Nos. 5,474,572 to Hayhurst and 5,645,553 to Kolesa et al. disclose the use of a hinged clip that snaps closed after the suture threads are placed within the holding members. The hinge clip is snapped into place such that the suture is held transversely across the holding members, thus locking the suture in place. There is a possibility of improperly actuating or inadvertently releasing the snap, which could lead to an insecure fixation of the suture. In addition, weak stress points are created where the suture is held within the clip.
In view of the deficiencies of the prior art discussed hereinabove, there remains a need for a suture anchoring device that is simple to use, particularly during laparoscopic surgery, in order to eliminate manual knot tying by the surgeon performing the surgical procedure, while not compromising the integrity of the suture.